Postpartum Hemorrhage Overview

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Questions and Answers

A new mother is experiencing unilateral breast swelling, redness, and tenderness, along with a burning sensation. She also reports a salty flavor in her milk. What condition is most likely causing these symptoms?

  • Sepsis
  • Wound infection
  • Endometritis
  • Mastitis (correct)

A nurse is caring for a newborn who is experiencing acrocyanosis. What actions should the nurse prioritize?

  • Monitor the newborn's respiratory rate and effort
  • Administer antibiotics to prevent infection
  • Perform a full skin assessment to rule out other skin conditions
  • Warm the newborn's hands and feet with a warm compress (correct)
  • Increase the newborn's fluid intake to promote hydration

What nursing intervention is considered essential for a postpartum patient experiencing endometritis?

  • Administer antibiotics and monitor lochia (correct)
  • Administer pain medication and monitor for fever
  • Ensure adequate hydration and encourage early ambulation
  • Provide perineal care with a peri bottle and warm water
  • Encourage frequent breast-feeding to promote uterine contractions

Which factor plays a significant role in the development of hypothermia in newborns?

<p>Exposure to cold environments and evaporation of amniotic fluid (D)</p> Signup and view all the answers

A postpartum patient is concerned about breastfeeding after being diagnosed with mastitis. What should the nurse advise the patient?

<p>Continue breastfeeding as it does not harm the baby and helps clear the infection (A)</p> Signup and view all the answers

Which nursing intervention is most effective in preventing wound infections in postpartum patients?

<p>Maintaining a clean and dry wound environment (C), Providing education on perineal care, including the use of a peri bottle (D)</p> Signup and view all the answers

What is a common symptom of sepsis in a postpartum patient?

<p>Elevated temperature (E)</p> Signup and view all the answers

Jaundice in a newborn is a result of:

<p>The breakdown of excess red blood cells by the liver (A)</p> Signup and view all the answers

What is a common emotional experience known as 'baby blues' characterized by?

<p>Temporary emotional lability after birth (C)</p> Signup and view all the answers

What is a significant risk factor for developing postpartum depression?

<p>Previous mental health issues during pregnancy (A)</p> Signup and view all the answers

What should be done to care for a newborn's umbilical cord stump?

<p>Keep diapers rolled below the stump until it falls off (D)</p> Signup and view all the answers

What is the recommended position for a car seat for a child up to two years old?

<p>Rear-facing until two years old (C)</p> Signup and view all the answers

Which of the following symptoms should prompt a caregiver to call a newborn's primary care provider?

<p>A temperature greater than 100.4 F rectal (A)</p> Signup and view all the answers

What is the recommended frequency for bathing a newborn in the first few weeks?

<p>Three times a week is sufficient (B)</p> Signup and view all the answers

What are signs indicating a need for immediate care for a newborn?

<p>Foul-smelling discharge from the umbilical area (D)</p> Signup and view all the answers

Which of the following describes a common behavior seen in younger siblings after the arrival of a new baby?

<p>Regression in behavior due to divided attention (B)</p> Signup and view all the answers

What clinical manifestation might indicate a newborn is experiencing kernicterus?

<p>Seizures (C)</p> Signup and view all the answers

Which diagnostic test is used to assess the presence of fetal antibodies in the context of Rh incompatibility?

<p>Direct Coombs test (B)</p> Signup and view all the answers

Which of the following is a sign of appropriate bonding between a parent and a newborn?

<p>Affectionate actions (B)</p> Signup and view all the answers

What bilirubin level in newborns within the first 24 hours is concerning?

<p>Bilirubin &gt; 12 mg/dL (C)</p> Signup and view all the answers

During which stage of maternal role attainment does a mother primarily focus on her own experiences after birth?

<p>Stage 1: Taking in (A)</p> Signup and view all the answers

Which of the following is considered a risk factor for delayed bonding between a parent and their newborn?

<p>Young maternal age (D)</p> Signup and view all the answers

Which of the following nursing interventions is crucial for managing hyperbilirubinemia in newborns?

<p>Phototherapy management (A)</p> Signup and view all the answers

What clinical manifestation could suggest a rapid breakdown of RBCs in a newborn?

<p>Lethargy (D)</p> Signup and view all the answers

At what age should cervical cancer screening begin using the Pap test?

<p>21 years (C)</p> Signup and view all the answers

How often should individuals aged 30-65 receive Pap tests if combined with HPV screening?

<p>Every 5 years (D)</p> Signup and view all the answers

Which family planning method involves tracking basal body temperature?

<p>Natural family planning (A)</p> Signup and view all the answers

What is the recommended timeframe for leaving a diaphragm in place after intercourse?

<p>At least 6 hours but no more than 24 hours (C)</p> Signup and view all the answers

Which of the following methods allows for family planning while exclusively breastfeeding?

<p>Lactation amenorrhea method (C)</p> Signup and view all the answers

What should be done before choosing a family planning method?

<p>Obtain physical exam and discuss client preferences (B)</p> Signup and view all the answers

What appearance does cervical mucus have during the fertile period?

<p>Egg white appearance (A)</p> Signup and view all the answers

What is the correct approach for using spermicide?

<p>Placed 15 minutes before and lasts about an hour (C)</p> Signup and view all the answers

What condition is a contraindication for the use of combined oral contraceptives?

<p>Breast cancer (C)</p> Signup and view all the answers

What is the maximum time a cervical cap should be left in place?

<p>24 hours (B)</p> Signup and view all the answers

Which of the following is a potential therapeutic effect of combined oral contraceptives?

<p>Preventing acne (C)</p> Signup and view all the answers

Which medication class can decrease the effectiveness of combined oral contraceptives due to their effect on liver enzymes?

<p>Anticonvulsants (C)</p> Signup and view all the answers

What is the primary action of progestin-only pills?

<p>Suppress ovulation (B)</p> Signup and view all the answers

What symptom should prompt a patient to seek medical attention while on combined oral contraceptives?

<p>Leg pain (C)</p> Signup and view all the answers

What is the recommended action if a patient misses two doses of their combined oral contraceptive?

<p>Use alternative contraception and follow specific directions (D)</p> Signup and view all the answers

The contraceptive sponge primarily works by which mechanism?

<p>Physical barrier and chemical barrier (B)</p> Signup and view all the answers

Which of the following is NOT a reason to switch or stop the use of combined oral contraceptives?

<p>Mild migraines (D)</p> Signup and view all the answers

What is the minimum duration a contraceptive sponge should be left in place?

<p>6 hours (B)</p> Signup and view all the answers

Flashcards

Lanugo

Fine hair on newborns that helps keep them warm in utero.

Sutures of the skull

Not fused; allows delivery and skull growth in newborns.

APGAR score

Assessment of newborn's health after birth; scored at 1 and 5 minutes.

Appearance in APGAR

Skin color scoring: 0 (pale/blue), 1 (pink body/blue extremities), 2 (entirely pink).

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Grimace in APGAR

Refers to newborn's response: 0 (no response), 1 (grimaces), 2 (grimaces and cries).

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Moro reflex

Startle reflex in newborns, where arms spread out and then retract.

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Caput succedaneum

Fluid under the skin of a newborn's head from delivery pressure; crosses suture lines.

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Cleft palate

Condition where there is an opening in the roof of the mouth; assessed by mouth inspection.

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Mastitis

Infection of the breast often presenting as fever, redness, and abnormal milk.

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Signs of Mastitis

Includes fever, unilateral swelling, tender and red breast, and salty milk.

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Sepsis

A severe infection that spreads throughout the body, typically requiring urgent treatment.

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Wound Infections

Infections occurring at incision sites from surgeries such as C-section.

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Endometritis

Infection of the endometrium, often necessitating antibiotics and pain management.

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Thermoregulation

The body's ability to maintain stable internal temperature, crucial after birth.

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Acrocyanosis

Bluish discoloration of hands and feet in newborns, usually harmless.

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Hyperbilirubinemia

Condition caused by excess bilirubin, leading to jaundice (yellow skin and eyes).

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Skin to Skin

Physical contact between parent and newborn for bonding.

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ABO & Rh Incompatibility

When a mother's blood type conflicts with her baby's, risking anemia and jaundice.

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Direct Coombs Test

A test to check for antibodies in the baby's blood indicative of incompatibility.

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Clinical Manifestations of Hyperbilirubinemia

Signs include jaundice, lethargy, poor feeding, and seizures.

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Phototherapy Management

Treatment using light to reduce bilirubin levels in newborns.

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Maternal Role Attainment

Stages of a mother's adaptation to her new role post-birth.

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Bonding Signs

Indicators of healthy parent-newborn bonding, like affection and care.

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Pelvic exams

Medical examinations focusing on female reproductive organs to detect issues like cancer and STIs.

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Pap test

A test that detects cervical cancer through sampling cells from the cervix.

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Age for Pap test

Women aged 21-29 should have a Pap test every 3 years; those 30-65 every 5 years with HPV screening.

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Transgender men's care

Focus on preventative care and comfort in medical appointments for transgender men.

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Natural family planning

Methods to track fertility using body signals like temperature and mucus changes.

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Barrier methods

Contraceptive methods that create a physical barrier to prevent sperm from reaching the uterus.

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Cervical mucus ovulation

Utilizing changes in cervical mucus to identify fertile periods for conception.

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Lactation amenorrhea method

A contraceptive method relying on exclusive breastfeeding to delay ovulation for up to 6 months post-birth.

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Letting Go Stage

Time when a mother integrates new roles, taking months.

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Baby Blues

Temporary emotional changes in the first two weeks after birth.

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Postpartum Depression

Intense feelings of anxiety, sadness, and irritability after birth.

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Postpartum Risk Factors

Factors increasing chances of postpartum depression.

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Newborn Bathing Guidelines

First bath should be 24 hours after birth without lotion for 2 weeks.

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Umbilical Cord Care

Keep diaper rolled below until cord falls off; lasts 1-2 weeks.

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Car Seat Safety

Keep car seat rear-facing until 2 years old; ensure snug straps.

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When to Call PCP

Call if newborn has temp over 100.4 F or shows signs of illness.

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Cervical cap

A contraceptive device that fits over the cervix and can be used with spermicide.

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Contraceptive sponge

A device that acts as a physical and chemical barrier to prevent pregnancy.

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Toxic Shock Syndrome (TSS)

A serious illness that can occur from leaving contraceptive devices in too long.

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Combined oral contraceptives (COC)

Pills containing estrogen and progestin that suppress ovulation.

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Progestin-only pills (minipill)

Birth control pills that only contain progestin to prevent ovulation.

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Patient education for COC

Instructions include taking missed doses ASAP and reporting serious symptoms.

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COC side effects

Common side effects include headache, nausea, and breast tenderness.

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Thromboembolic disorders

Conditions contraindicating the use of combined oral contraceptives.

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Consistency with minipills

Essential to take progestin-only pills at the same time every day.

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Health risks with COC

COC cannot be used by women with certain health issues like stroke or heart disease.

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Study Notes

Postpartum Hemorrhage

  • Cumulative blood loss greater than 500 mL after vaginal delivery, and greater than 1000 mL after C-section delivery
  • Early PPH: occurs within 24 hours of birth
  • Secondary PPH: occurs 24 hours to 6 weeks after birth
  • Clinical manifestations include a boggy uterus, possible deviation to the right, full bladder, and heavy vaginal bleeding with clots
  • Signs of hypovolemic shock (hypotension, tachycardia)

PPH Causes and Interventions

  • Tone: Uterine atony (lack of contraction)
    • Interventions: Fundal massage, oxytocin medication
  • Trauma: Lacerations
    • Interventions: Repair of lacerations, suturing
  • Tissue: Retained products of conception (e.g., placenta)
    • Interventions: Surgical removal (e.g., D&C)
  • Thrombin: Coagulation problems
    • Interventions: Fundal massage, oxytocin medication, decrease blood loss

PPH Treatment

  • Massage the fundus to contract the uterus and push down the vessels
  • Bimanual exam to apply pressure to the fundus
  • Medications: Oxytocin, Misoprostol, Methylergonovine, Tranexamic acid to increase clotting factors

Other Postpartum Complications

  • Retained placenta: Placenta not delivered within 30 minutes, or significant blood loss before delivery. Manual removal or D&C is required.
  • Subinvolution of uterus: Uterus does not shrink, leading to continued bleeding.
  • Lacerations: Trauma to the perineal area requiring repair.
  • Hematomas: Localized swelling and pain, especially after C-section or vaginal delivery.
  • Deep vein thrombosis (DVT): Increased risk with C-Sections, requiring careful monitoring and treatment.

Nursing Interventions

  • Expectant: Pain medication, ice packs for mild cases
  • Surgical: Vascular embolization, arterial embolization to stop bleeding
  • Postpartum Shock: Monitor vital signs (tachycardia, hypotension), provide fluids and oxygen support, possibly blood transfusions.
  • Endometritis (uterus infection): Monitor for fever, foul-smelling lochia. Administer antibiotics
  • Mastitis: Monitor for breast tenderness, warmth, or redness. Treat with antibiotics and pain relievers.
  • Wound care: Assess for redness, swelling, pain, and drainage at incisional sites

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